Home
|
Inbox
|
Search
|
View Abstract
Uncal Herniation with Full Neurological Recovery
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A6875 - Uncal Herniation with Full Neurological Recovery
Author Block: J. Stoll1, J. Xu1, L. Hou1, W. Khan2; 1Internal Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States, 2Pulmonary/Critical Care, University Medical Center at Princeton Plainsboro, Princeton, NJ, United States.
Introduction Brainstem herniation is a serious and often fatal complication of acute increased intracranial pressure (ICP). The etiology of ICP can include a mass, an increase in cerebrospinal fluid (CSF), or intracranial hemorrhage. We present a case of uncal hernation with compression of the bilateral contours of the upper brainstem. In our case, due to early interventions, the patient was able to make a full neurologic recovery without residual deficits.
Case A 48-year-old male presented to the emergency room for recurrent syncope. He became acutely unresponsive. Physical exam at that time was notable for pupils which became fixed and dilated. Emergent computed tomography of the head revealed a ventricular colloid cyst with hydrocephalus and uncal herniation. Emergent bedside bilateral external ventricular drains were placed in the emergency room. Mechanical ventilation was initiated due to depressed mental status. The patient regained consciousness spontaneously after forty-eight hours. He underwent surgical resection of the colloid cyst. After approximately 2 weeks, he was discharged home with no residual neurologic deficits.
Discussion The ability to identify and treat a patient with increased intracranial pressure is critical for functional outcomes. It is quite rare for a patient to have uncal herniation and to then have meaningful neurologic recovery. Multiple studies in the past have indicated the high mortality rate and severely impaired functional status after herniation[1],[2]. Timely and aggressive intervention, even if herniation has already occurred can lead to improved outcomes[3]. This case illustrates how prompt intervention is crucial to functional recovery after uncal herniation
[1] Skoglund TS, Nellgard B: Long-time outcome after transient transtentorial herniation in patients with traumatic brain injury. Acta Anaesthesiol Scand 2005, 49(3):337-340. [2] Andrews BT, Pitts LH: Functional recovery after traumatic transtentorial herniation. Neurosurgery 1991, 29(2):227-231. [3] Qureshi AI, Geocadin RG, Suarez JI, Ulatowski JA: Long-term outcome after medical reversal of transtentorial herniation in patients with supratentorial mass lesions. Crit Care Med 2000, 28(5):1556-1564.
Author Block: J. Stoll1, J. Xu1, L. Hou1, W. Khan2; 1Internal Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States, 2Pulmonary/Critical Care, University Medical Center at Princeton Plainsboro, Princeton, NJ, United States.
Introduction Brainstem herniation is a serious and often fatal complication of acute increased intracranial pressure (ICP). The etiology of ICP can include a mass, an increase in cerebrospinal fluid (CSF), or intracranial hemorrhage. We present a case of uncal hernation with compression of the bilateral contours of the upper brainstem. In our case, due to early interventions, the patient was able to make a full neurologic recovery without residual deficits.
Case A 48-year-old male presented to the emergency room for recurrent syncope. He became acutely unresponsive. Physical exam at that time was notable for pupils which became fixed and dilated. Emergent computed tomography of the head revealed a ventricular colloid cyst with hydrocephalus and uncal herniation. Emergent bedside bilateral external ventricular drains were placed in the emergency room. Mechanical ventilation was initiated due to depressed mental status. The patient regained consciousness spontaneously after forty-eight hours. He underwent surgical resection of the colloid cyst. After approximately 2 weeks, he was discharged home with no residual neurologic deficits.
Discussion The ability to identify and treat a patient with increased intracranial pressure is critical for functional outcomes. It is quite rare for a patient to have uncal herniation and to then have meaningful neurologic recovery. Multiple studies in the past have indicated the high mortality rate and severely impaired functional status after herniation[1],[2]. Timely and aggressive intervention, even if herniation has already occurred can lead to improved outcomes[3]. This case illustrates how prompt intervention is crucial to functional recovery after uncal herniation
[1] Skoglund TS, Nellgard B: Long-time outcome after transient transtentorial herniation in patients with traumatic brain injury. Acta Anaesthesiol Scand 2005, 49(3):337-340. [2] Andrews BT, Pitts LH: Functional recovery after traumatic transtentorial herniation. Neurosurgery 1991, 29(2):227-231. [3] Qureshi AI, Geocadin RG, Suarez JI, Ulatowski JA: Long-term outcome after medical reversal of transtentorial herniation in patients with supratentorial mass lesions. Crit Care Med 2000, 28(5):1556-1564.
|
Home
|
Inbox
|
Search
|